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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here.


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Old 06-14-2007, 05:32 PM
LBP LBP is offline
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Join Date: Aug 2005
Posts: 446
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Ronald...there is someone else that used to post
on this website who was denied by his ins but
then got it approved because he has FEHB benefits....

member 317 (sfmcfar) is a federal employee and was twice denied by Maryland Individual Practice Association, now known as an HMO with Mid-Atlantic Medical Services, now owned by United Healthcare. However, he appealed to the Office of Personnel Management (OPM) and won. Apparently, the OPM determined that the insurer applied their guidelines incorrectly and stated that it was improper to categorize an FDA approved device as experimental and investigational.

If this worked for this guy..I don't get why you are having so much trouble. A long time ago I read several big health ins companies policies denying ADR coverage with an explicit exception for federal employees?!?!?!

You do have a copy of the FEHB policy, right? http://www.charitedisc.com/charitedev/domestic/patients...sement/fedappeal.pdf


See prior thread...you'll find his post
http://adrsupport.org/eve/forums/a/tpc/f/7701036081/m/9...331018081#9331018081
__________________
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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Old 06-23-2007, 10:14 PM
LBP LBP is offline
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Join Date: Aug 2005
Posts: 446
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Does anyone know who this Ronald is? It concerns me that someone with FEBH (fed ins) is not getting ADR coverage!!! This is supposed to be a slam dunk. Wondering if there's been a change in their policy?
__________________
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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